Hydronephrosis

Hydronephrosis, a systemic condition that causes the kidneys to become enlarged, affects many people worldwide. This common kidney problem occurs when urine can't drain properly from the kidneys, leading to fluid buildup. Understanding hydronephrosis is crucial because it can cause discomfort and, if left unattended, may lead to serious kidney damage. In this blog, we'll explore the ins and outs of one of the common kidney problems, hydronephrosis. 

What is Hydronephrosis? 

Hydronephrosis is a condition that affects one or both kidneys, causing them to swell up due to a buildup of urine. This condition happens when urine can't drain properly from the kidneys to the bladder. It's like having a blocked pipe in your plumbing system, but instead of water, it's urine that's backing up. Symptoms can be sudden or chronic, partial or complete. Unilateral hydronephrosis refers to the condition where only one kidney is affected, and bilateral hydronephrosis refers to the condition in which both kidneys are affected. 

Symptoms of Hydronephrosis 

Hydronephrosis often doesn't cause noticeable symptoms, especially in its early stages. However, as the condition progresses, various signs may appear.

In infants with congenital hydroureteronephrosis, symptoms are typically absent. However, severe cases might lead to: 

• Lack of appetite 
• Frequent urinary tract infections (UTIs) 

The symptoms can be more pronounced for adults, mainly when an acute urinary outflow obstruction occurs. Common signs include: 

• A constant dull ache in the side, lower back, or abdomen 
• Occasionally, patients experience severe pain episodes due to genitourinary peristalsis, which temporarily increases pressure. 
• Nausea and vomiting 
• Painful urination (dysuria) 
• Urinary urgency 
• Difficulty emptying the bladder completely 
• Changes in urination frequency (more or less than usual) 
• Blood in the urine 

Urinary tract infections (UTIs): 

• Fever and chills 
• Fatigue 
• In cases where the obstruction is more distal, such as from prostate hypertrophy, patients might experience: 
• Severe lower abdominal pressure 
• A strong urge to urinate 

Causes of Hydronephrosis 

The following are some of the most common causes of hydronephrosis: 

• Intrinsic Causes: These involve obstructions that originate within the urinary tract itself: 
  • Kidney stones 
  • Urinary tract infections (UTIs) 
  • Defects present at birth, such as urethral valves or strictures. 
  • Cancerous growths in the bladder, prostate, cervix, or colon. 
  • Narrowing of the ureters due to scarring from previous injury or surgery. 
  • Ureterocele, where the lower part of the ureter protrudes into the bladder. 
• Extrinsic causes: These involve external factors that compress the urinary tract: 
  • Pregnancy 
  • Enlarged prostate 
  • Retroperitoneal fibrosis 
  • Pelvic or abdominal tumours 
• Other Causes: 
  • Nerve or muscle problems affecting the kidneys or ureters 
  • Vesicoureteral reflux occurs when urine the flow of urine goes backwards from the bladder to the kidneys 
  • Urinary retention or a person's inability to empty the bladder completely 

Complications of Hydronephrosis 

Hydronephrosis, while not a disease itself, can lead to severe complications if left untreated, including: 

• Urinary tract infections (UTIs) 
• Irreversible kidney damage 
• Kidney failure 
• Bilateral hydronephrosis poses an even greater risk, involving the enlargement of the parts of the kidneys that collect urine on both sides. 
• For pregnant women, hydronephrosis can present unique challenges. The condition may result in pain in the lower abdomen or back, frequent urination, and an increased risk of UTIs. 

Hydronephrosis Diagnosis 

The diagnostic process involves: 

• Medical History Review and Physical Examination: The doctors will ask about any symptoms and examine the area surrounding the kidneys and bladder for tenderness or swelling. They may also inquire about the patient's and their family's medical history. For male patients, a rectal exam might be necessary to check for an enlarged prostate. Those with a vagina might need a pelvic exam to evaluate any issues with the uterus or ovaries. 
• Urine Analysis: Urine tests to check blood, stone crystals, bacteria, or signs of infection. 
• Blood Picture: Blood analysis includes a complete blood count (CBC) to check for infection and tests of kidney function such as creatinine, estimated GFR (eGFR), and blood urea nitrogen (BUN). 
• Advanced Imaging: 
  • Imaging procedures such as ultrasound, CT scan, or MRI 
  • A voiding cystourethrogram is recommended for infants with congenital hydroureteronephrosis to identify patients with vesicoureteral reflux. 
  • In cases where the obstruction is suspected, doctors may perform a nuclear medicine diuretic renogram to assess urine flow and differentiate it from other causes, such as an extra-renal pelvis or parapelvic cysts. 

Treatment 

For mild hydronephrosis treatment, doctors may recommend a "wait and see" approach, as some instances resolve over time without intervention. However, active hydronephrosis treatment is necessary for more severe cases or those causing complications. Treatment includes: 

• Draining Excess Urine: 
  • To provide immediate relief and prevent further hydronephrosis kidney damage, doctors often start by draining the excess urine through: 
  • Urinary catheterization 
  • Nephrostomy tube 
  • A ureteral stent to hold the ureters open, allowing urine to flow normally. 
• Treating Underlying Causes: Once the immediate pressure is relieved, treatment focuses on addressing the root cause: 
  • Kidney Stones: If stones are causing the obstruction, treatment options include: 
    • Shock wave lithotripsy 
    • Ureteroscopy 
    • Surgery for very large or difficult-to-remove stones 
  • Infections: Doctors may prescribe antibiotics if a urinary tract infection (UTI) is present or the urinary tract is narrowed due to infection. 
  • Tumours or Other Blockages: Surgery may be necessary to remove tumours, scar tissue, or other obstructions. 
  • During pregnancy, treatment typically involves: 
    • Regular catheterization to drain urine 
    • Pain management 
    • Antibiotics if a UTI develops 
• Long-term Management: For some patients, ongoing management may be necessary: 
  • Follow-up imaging studies to assess kidney function and hydronephrosis status 
  • Monitoring for improvement or worsening of the condition 
  • Regular replacement of ureteral stents 

When to See a Doctor 

People should contact their doctor if they experience any of the following hydronephrosis symptoms: 

• Sudden or intense pain in the side or back 
• Vomiting 
• Any noticeable changes in urinary habits 
• Urinating more or less frequently than usual 
• Experiencing pain or discomfort while urinating 
• Noticing blood in the urine 
• Fever above 100.5 degrees Fahrenheit (38 degrees Celsius) 

Prevention of Hydronephrosis

Preventing hydronephrosis depends on avoiding or promptly treating its underlying causes. These include: 

• Drink plenty of water to maintain a minimum of 2000 mL urine output daily 
• Limit salt intake 
• Moderate animal protein intake 
• Balance calcium intake 
• Maintain good hygiene 
• Urinate regularly and after sexual activity 
• Regular prostate check-ups 
• Limit high-oxalate foods 

Conclusion 

Hydronephrosis is a serious kidney condition that has an impact on the quality of life. Its causes range from kidney stones to pregnancy-related issues, and it can lead to complications if left untreated. Early detection and proper treatment plan are crucial to prevent long-term kidney damage. By understanding the symptoms and risk factors, people can take proactive steps and improve their kidney health. 

FAQ's 

1. How common is hydronephrosis? 

Hydronephrosis is a relatively common condition. It can affect people of all ages, with a male-to-female ratio of 2:1. 

2. Does drinking water help hydronephrosis? 

While drinking water doesn't directly cure hydronephrosis, maintaining adequate fluid intake is crucial for overall kidney health. Increased fluid intake can help: 

• Prevent stone formation 
• Reduce the risk of urinary tract infections 
• Promote urine flow 

3. What should you avoid if you have hydronephrosis? 

If you have hydronephrosis, avoiding factors that could worsen the condition or increase the possibility of complications is essential. Here are some key points: 

• Limit salt intake 
• Moderate animal protein intake 
• Balance calcium intake 
• Avoid high-oxalate foods 
• Limit phosphorus and potassium 
• Reduce processed foods 
• Avoid holding urine for long periods 

4. What is the leading cause of hydronephrosis? 

The leading cause of hydronephrosis is a blockage or obstruction in the urinary tract that prevents urine from flowing normally from the kidneys to the bladder. 

5. Can you recover fully from hydronephrosis? 

The potential for complete recovery from hydronephrosis depends on several factors, including the underlying reason, the severity of the condition, and how quickly it's treated. 

6. Can hydronephrosis be cured? 

Hydronephrosis is often treatable; in many cases, it can be effectively managed or cured. The treatment approach depends on the underlying ailment and the severity of the condition. 

Dr. Utkarsh Deshmukh

MBBS, DNB (General Medicine), DNB (Nephrology)
Ganga CARE Hospital Limited, Nagpur

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